a disproportionate burden of CRC incidence and mortality, mainly due to lower utilization of recommended CRC screening tests. The Appalachian region of Ohio suffers from this burden of disease in addition to higher poverty, lower employment, and lower educational levels. To address this cancer health disparity, our health disparities research team at The Ohio State University (OSU) in partnership with four Appalachia-based community coalitions have used community-based participatory research (CBPR) methods to design and pilot test two interventions intended to increase CRC screening rates in one Appalachian county (Phase 1). The goal of this application is to test these CRC screening interventions in 12 Ohio Appalachian counties (Phase 2) in preparation for a full-scale dissemination trial (Phase 3) in 6 additional Appalachian states within the Appalachia Community Cancer Network (ACCN). The specific aims of this Phase 2 proposal are to: 1) utilize CBPR methods to refine specific county-level media campaigns and clinic-based messages about CRC screening (entitled Get Behind Your Health!) or an attention control message (a healthy eating campaign entitled PEACHES) in 12 Ohio Appalachia counties; 2) implement and test, using a group-randomized design, a staggered county-wide intervention program that compares county-specific media campaigns featuring local CRC survivors, clinic-specific charter reminder systems, and a combination of the two strategies in 6 randomly selected intervention counties to the same campaign strategies in 6 randomly selected attention control counties using county specific healthy eating campaigns featuring local farmers and educational material placed in clinics; 3) utilize process (convenience samples of county residents) and outcome evaluation (4 independent cross-sectional surveys of residents of each county) strategies to assess the efficacy of each strategy on improving CRC screening rates; and 4) utilize the results, to plan the dissemination of the intervention into 36 Appalachian counties in 6 additional states of the ACCN in a subsequent Phase 3 study. All specific aims will be carried out using CBPR principles, in full partnership with these four Ohio Appalachian community-based cancer coalitions, and will be guided by an underlying theoretical framework of the Transtheoretical Model, in conjunction with three behavioral theories relevant to behavior change (Social Cognitive Theory, Theory of Reasoned Action, and Attitude Accessibility Theory). The results of this study, thus, will have immediate impact in these Appalachian counties, as the community will be able to institutionalize successful strategies into existing county-wide health campaigns.